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Orthopaedic Surgery 11/2012; 4(4):266-8.
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ABSTRACT: The literature on tuberculosis of the posterior spinal elements without involvement of the vertebral body is scarce. In this study we report our experience with twenty-four cases of neural arch tuberculosis that were treated at our center.
We performed a retrospective review of the clinical and radiographic data of twenty-four consecutive patients who had tuberculosis of the posterior spinal elements with total sparing of the vertebral bodies and intervertebral disc space. We categorized the patients into two groups on the basis of the clinical and radiographic evaluation. The patients who had rapid onset weakness of the lower limbs or pyramidal signs or who showed evidence of epidural abscess underwent emergency decompressive laminectomy (Group A). Patients who had pyomyositis of the posterior spinal muscles without any neurological deficit, pyramidal signs, or epidural abscess were managed with antitubercular therapy alone (Group B).
The common presenting features were spastic limb weakness and back pain. The majority of the patients had involvement of the thoracic spine. Epidural abscess, erosion of lamina, and pyomyositis of posterior spinal muscles were common imaging findings. Group A consisted of nineteen patients and Group B consisted of five patients. The mean period of follow-up was 16.9 months (range, nine to sixty months). Patients in Group A had a poorer outcome than those in Group B. Thirteen of the nineteen patients in Group A improved to become independent in the activities of daily living, with complete neurological recovery in eight patients and partial recovery in five patients. Six of the nineteen patients continued to have spastic paraplegia and were wheelchair-dependent. All of the patients in Group B remained neurologically intact during the follow-up period. None of the patients had recurrence of the disease or developed anterior element involvement or kyphotic deformity during the follow-up period.
Neural arch tuberculosis is often missed at the time of initial presentation. In association with epidural abscess, it leads to rapid neurological deterioration. This atypical picture of spinal tuberculosis showed a high rate of neurological deficit at the time of initial presentation for medical care.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 10/2012; 94(20):e1511-8. · 3.27 Impact Factor
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ABSTRACT: Monteggia fracture dislocations are uncommon in childhood. Over a period of time, various equivalents of this entity have
been described. These fractures with concomitant elbow injuries are exceedingly rare in young children. We present a case
of a 6-year-old boy who sustained a fracture of proximal ulna with ipsilateral supracondylar fracture humerus. We suggest
that the fracture pattern can be included under type I Monteggia equivalent on the basis of its characteristics, biomechanics
and the mode of injury.
KeywordsMonteggia lesions–Monteggia equivalents–Supracondylar fracture
04/2012; 3(2):82-85.
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ABSTRACT: PurposeThe World Health Organisation has declared tuberculosis (TB) a global emergency and spinal tuberculosis is one of the most
common forms. There is still controversy regarding optimum duration of treatment in osteoarticular tuberculosis due to the
lack of well-defined criteria for the end point of treatment. Emergence of multi drug resistant tuberculosis, primarily due
to use of poor drug regimens, further illustrates the need of newer and more effective diagnostic methods, particularly in
developing countries.
MethodsThis prospective clinical study to evaluate the role of technetium (99mTc)–ciprofloxacin scan as a tool to assess disease activity involved in 15 cases of TB spine with a mean age of 32.2 years
(range 21–72). Following a clinico-radiological diagnosis, all patients were treated with standard anti tubercular treatment
and a scan was done at zero, three and six months of treatment with tracer activity being recorded and compared in sequential
scans along with a parallel evaluation of clinical and radiological profile at regular intervals.
ResultsOut of 15 cases, nine had an initially positive bone scan. Two patients (22%) converted to negative scans at three months,
whereas the remaining seven (78%) turned negative at six months. The end of six months treatment was also accompanied by clinico-radiological
resolution in all cases.
ConclusionIn conclusion, technetium (99mTc)–ciprofloxacin scan could be a promising tool for monitoring disease activity in selected cases of tuberculosis spine as
an alternative for therapeutic drug monitoring; however, due to the small sample size, studies with a large number of patients
might be of help in defining these cases in a better way.
International Orthopaedics 04/2012; 36(2):271-276. · 2.03 Impact Factor
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ABSTRACT: Immobilization of lower limb following neurorrhaphy for sciatic nerve injuries poses a difficult clinical situation both for
the surgeon and for the patient. In this article, we describe a new technique for maintenance of lower limb in desired position
of extension at hip and flexion of knee without application of spica cast using an external fixator. In this method, a spanning
external fixator across the knee and hip joint is applied in the desired position following neurorrhaphy, and both joints
are sequentially brought back to normal position. Clinical follow-up of 2 cases is also presented with preservation of range
of motion at hip and knee joint as well as good functional outcome of nerve repair.
KeywordsSciatic nerve–External fixator–Neurorrhaphy
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 21(2):135-137. · 0.10 Impact Factor
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ABSTRACT: Muscle abscess presenting as nerve palsy is rare and has not been previously reported in the common peroneal nerve (CPN). The objective of this case report is to describe the diagnosis and treatment of an uncommon presentation of peroneal abscess in the leg of an otherwise healthy man. We present a case of CPN palsy in a 50-year-old immunocompetent man with no other comorbid medical condition secondary to peroneus longus abscess. The diagnosis was suggested by magnetic resonance imaging examination and confirmed by intraoperative findings. After surgical drainage of the abscess, the patient made a complete recovery. A review of the literature confirms that peroneus longus abscess giving rise to CPN palsy has not been described. Early diagnosis and surgical drainage of the compressing abscess can produce a favorable outcome.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 02/2012; 51(4):479-81.
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ABSTRACT: Tuberculosis is one of the oldest diseases affecting mankind and is known for its ability to present in various forms and guises. Pubic symphysis is an uncommon site for tuberculous affliction; hence very few cases have been reported in the English-language literature. We present a rare case of pubic symphysis tuberculosis diagnosed as osteitis pubis before presentation to our institution. The patient made an uneventful recovery following antitubercular chemotherapy.
acta orthopaedica et traumatologica turcica 01/2012; 46(3):223-7. · 0.34 Impact Factor
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Clinical Orthopaedics and Related Research 09/2011; 469(9):2670-5. · 2.53 Impact Factor
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ABSTRACT: The World Health Organisation has declared tuberculosis (TB) a global emergency and spinal tuberculosis is one of the most common forms. There is still controversy regarding optimum duration of treatment in osteoarticular tuberculosis due to the lack of well-defined criteria for the end point of treatment. Emergence of multi drug resistant tuberculosis, primarily due to use of poor drug regimens, further illustrates the need of newer and more effective diagnostic methods, particularly in developing countries.
This prospective clinical study to evaluate the role of technetium ((99m)Tc)-ciprofloxacin scan as a tool to assess disease activity involved in 15 cases of TB spine with a mean age of 32.2 years (range 21-72). Following a clinico-radiological diagnosis, all patients were treated with standard anti tubercular treatment and a scan was done at zero, three and six months of treatment with tracer activity being recorded and compared in sequential scans along with a parallel evaluation of clinical and radiological profile at regular intervals.
Out of 15 cases, nine had an initially positive bone scan. Two patients (22%) converted to negative scans at three months, whereas the remaining seven (78%) turned negative at six months. The end of six months treatment was also accompanied by clinico-radiological resolution in all cases.
In conclusion, technetium ((99m)Tc)-ciprofloxacin scan could be a promising tool for monitoring disease activity in selected cases of tuberculosis spine as an alternative for therapeutic drug monitoring; however, due to the small sample size, studies with a large number of patients might be of help in defining these cases in a better way.
International Orthopaedics 07/2011; 36(2):271-6. · 2.03 Impact Factor
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ABSTRACT: The Ponseti method has been reported to have successful results in clubfoot patients less than 6 months of age but the literature on its efficacy in older clubfoot patients still remains sparse. In our study, we prospectively evaluated 55 clubfeet (37 patients) to determine clinically whether the Ponseti method is effective in the management of clubfoot in older children between the age of 12 and 36 months (mean: 24.8 months). All the patients belonged to moderate or severe grades of deformity as per the Pirani scoring. Painless, supple, plantigrade and cosmetically acceptable feet were achieved in 49 clubfeet. Seven patients (seven feet) developed recurrence of adduction, varus and equinus deformity whereas three patients (five feet) developed isolated recurrence of equinus deformity. These seven patients responded to repeat treatment and obtained satisfactory outcome. Four of these seven patients underwent tibialis anterior transfer to third cuneiform for dynamic supination. Three patients, those developed isolated recurrence of equinus deformity, underwent repeat tenotomy. One foot achieved satisfactory amount of dorsiflexion, three feet underwent tendoachilles lengthening whereas another foot underwent posterior release to obtain satisfactory dorsiflexion. Six to 12 numbers of casts (mean: 10) were required to obtain correction of clubfoot deformities. Mean period of immobilization in a cast was 13.9 weeks (10-15 weeks). We found that the Ponseti method is effective in children between the age of 12 and 36 months.
Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 06/2011; 21(1):79-84. · 0.66 Impact Factor
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ABSTRACT: There is scarce information on craniovertebral junction tuberculosis even in developing countries. The pendulum of treatment in craniovertebral junction tuberculosis has periodically vacillated between nonoperative management and radical surgery.
We performed a retrospective review of prospectively collected clinical and radiographic data on twenty-six consecutive patients with craniovertebral junction tuberculosis who were treated nonoperatively in our institution. The patients who had weakness of the limbs, pyramidal signs, or evidence of atlantoaxial dislocation and/or basilar invagination were immediately managed with immobilization with Crutchfield tongs traction (Group A), followed by halo-vest application. Patients without a neurological deficit, pyramidal signs, or atlantoaxial dislocation or basilar invagination were treated with cervical immobilization with early application of a halo vest (Group B).
The common presenting features were neck pain, restriction of neck movement, and spastic weakness of limbs. A retropharyngeal purulent fluid collection and osseous involvement of the dens and lateral mass of the atlas were the common radiographic findings. Twelve patients were partially or completely dependent on others for activities of daily living, and marked ligamentous and bone destruction with displacement at the atlantoaxial level was seen in eight patients at the time of presentation. The twenty patients in group A had cervical traction for a mean of 5.9 weeks, and a halo vest was applied for a mean of 6.9 months with antitubercular therapy for eighteen months. The mean follow-up period was 25.2 months (range, eighteen to forty-two months). All of the patients were independent in activities of daily living at the time of the last follow-up.
In the Indian subcontinent, the disease process of craniovertebral junction tuberculosis is usually quite advanced at the time of presentation. On the basis of our study, patients with craniovertebral junction tuberculosis can be managed successfully with nonoperative treatment even with advanced involvement of bone or soft tissues at this spinal level.
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 03/2011; 93(6):540-7. · 3.27 Impact Factor
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ABSTRACT: An anterior tibial artery pseudoaneurysm is a rare and unexpected complication of Steinmann pin insertion. We describe the case of an 18-year-old boy, who sustained such an injury to the anterior tibial artery during this procedure. Diagnosis was confirmed on a magnetic resonance (MR) angiogram. Aneurysmal sac excision with lateral repair of the vessel wall was performed. Postoperatively, a good flow was documented on a follow-up MR angiogram. This case highlights a major and unexpected complication of a so-called minor procedure. Too posterior a pin placement in the proximal tibia should be avoided to prevent such injuries.
Indian Journal of Orthopaedics 03/2011; 45(2):178-80. · 0.50 Impact Factor
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Journal of orthopaedic surgery (Hong Kong) 12/2010; 18(3):391-2; author reply 392-3.
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ABSTRACT: In the evidence-based medicine era, objective treatment guidelines have been laid down for pulmonary tuberculosis, but the same is not true for osteoarticular tuberculosis. This has led to demands for standardising the treatment protocol and to a lack of consensus between doctors regarding the composition and duration of treatment. Twenty-five patients with extraspinal osteoarticular tuberculosis were evaluated prospectively. Following the diagnosis, patients were given standard directly observed treatment short course (DOTS) regimen and were monitored for disease activity at zero, three and six months with the help of technetium-99m-labelled ciprofloxacin ((99m)Tc) scan. Tracer activity at the site was recorded and compared on sequential scans. Clinical and radiological profile of all the patients were also recorded at regular intervals and compared. All 25 cases had a positive (99m)Tc bone scan initially. Four patients (16%) converted to negative scans at three months, whereas the remaining 21 patients (84%) showed negative scans at six months. The end of six months therapy also coincided with resolution of clinical and radiological parameters in all cases. In conclusion, (99m)Tc scan is a promising tool for monitoring drug response in osteoarticular tuberculosis; however, due to the small sample size, studies with a large number of patients might be of help.
International Orthopaedics 11/2010; 35(12):1869-74. · 2.03 Impact Factor
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ABSTRACT: We describe a new pattern of upper limb injury: a combination of fractures of both radius and ulna, with a rare type of trans-scaphoid transcapitate transhamate greater arc injury of the wrist and fractures of metacarpals, managed successfully.
The Journal of hand surgery 07/2010; 35(7):1093-6. · 1.33 Impact Factor
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ABSTRACT: Langerhans cell histiocytosis is known to mimic many other conditions. We present two patients where anti-tubercular therapy was instituted when clinical and radiological features suggested tuberculosis. The correct diagnosis of histiocytosis was reached only on further work-up including immunohistochemistry following un-responsiveness to treatment. In retrospect it was felt that an inordinately high index of suspicion for tuberculosis, clinical and radiological overlap between the two entities, an urgency to start empirical therapy in a rapidly deteriorating patient and pathological similarities between epithelioid histiocytes and pathologic Langerhans cells led to the diagnostic and therapeutic errors.
Pediatric Blood & Cancer 02/2009; 53(1):111-3. · 1.89 Impact Factor
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ABSTRACT: Dupatta (scarf) is a part of the traditional dress for females in the Indian subcontinent. Working near machinery, riding a motorcycle or cyclerickshaw, can result in entanglement of dupatta in moving parts of machinery and subsequent cervical spine injury. It is seen most commonly in rural areas, with farmyard equipment.
A retrospective study was performed between January 2004 and January 2006, on all the patients presenting with cervical spine injury secondary to dupatta entanglement in machinery. They were assessed for mode, level of injury, neurological status, associated complications, radiological picture and clinical outcome.
There were 12 such cases of cervical spine injury. The most common cause of injury was a threshing machine. All cases except one had quadriplegia (ASIA grade A) with bladder and bowel involvement. There was loss of consciousness in nine patients. Three patients expired. There was no neurological recovery in any patient.
Dupatta is a unique cause of cervical spine injury in females, especially in rural areas. Easy methods of prevention may be helpful in preventing such injuries.
Injury 04/2008; 39(3):334-8. · 1.98 Impact Factor
